The American Society of Neurophysiological Monitoring (ASNM) was founded in 1989 as the American Society of Evoked Potential Monitoring. From the beginning, the Society has been made up of physicians, doctoral degree holders, Technologists, and all those interested in furthering the profession. The Society changed its name to the ASNM and held its first Annual Meeting in 1990. It remains the largest worldwide organization dedicated solely to the scientifically-based advancement of intraoperative neurophysiology. The primary goal of the ASNM is to assure the quality of patient care during procedures monitoring the nervous system. This goal is accomplished primarily through programs in education, advocacy of basic and clinical research, and publication of guidelines, among other endeavors. The ASNM is committed to the development of medically sound and clinically relevant guidelines for the performance of intraoperative neurophysiology. Guidelines are formulated based on exhaustive literature review, recruitment of expert opinion, and broad consensus among ASNM membership. Input is likewise sought from sister societies and related constituencies. Adherence to a literature-based, formalized process characterizes the construction of all ASNM guidelines. The guidelines covering the Professional Practice of intraoperative neurophysiological monitoring were initially published January 24th, 2013, and subsequently that document has undergone review and revision to accommodate broad inter- and intra-societal feedback. This current version of the ASNM Professional Practice Guideline was fully approved for publication according to ASNM bylaws on February 22nd, 2018, and thus overwrites and supersedes the initial guideline.

Summary:Purpose: To describe a new ictal sign in temporal lobe seizures-rhythmic ictal nonclonic hand (RINCH) motions and to determine its lateralizing significance and other ictal manifestations associated with it.Methods: We identified 15 patients with temporal lobe epilepsy who demonstrated RINCH motions and reviewed video-EEG recordings of all their seizures. We analyzed the epilepsy characteristics and all clinical features of recorded seizures, with particular attention to RINCH motions.Results: RINCH motions were unilateral, rhythmic, nonclonic, nontremor hand motions. RINCH motions were usually followed by posturing, sometimes with some overlap. They involved the hand contralateral to the temporal lobe of seizure onset in 14 of 15 patients.Conclusions: RINCH motions are a distinct ictal sign that could be considered a specific type of automatism. They appear to be a lateralizing contralateral sign and are associated with dystonic posturing in temporal lobe epilepsy. Key Words: Seizure semiology-Automatisms-Dystonic posturing-Temporal lobe epilepsy.Accurate localization of the epileptogenic zone is essential for successful epilepsy surgery. Although many tests contribute to the final localization, seizure semiology plays an important role in localization and lateralization (Kotagal et al., 1995;Kramer et al., 1997). The majority of patients seen for epilepsy surgery have temporal lobe epilepsy (TLE). In many patients with TLE, lateralization of the seizure focus is the major challenge, particularly when bilateral EEG abnormalities are in evidence. Dystonic posturing is one of the most reliable lateralizing signs in TLE, being contralateral to the hemisphere involved in the seizure activity. Manual automatisms have generally been regarded as lacking lateralizing significance, except when associated with dystonic posturing, which tends to inhibit or mask automatisms in the affected extremity (Serles et al., 1998;Kotagal, 1999). It is possible that the classification of automatisms so far has been too broad and that some movements classified as automatisms may be distinct in their characteristics.We observed distinctive nonclonic unilateral rhythmic hand (RINCH) motions during seizures in several patients with TLE undergoing seizure monitoring. We initially considered these rhythmic hand movements to be automatisms, but noted they were contralateral to the seizure focus. We studied these RINCH motions systematically in a consecutive series of patients. METHODSAfter our initial observation of RINCH motions, we identified 15 patients with epilepsy who demonstrated these motions and reviewed the video recordings of all their seizures. We recorded time of clinical and EEG onset, time and duration of the rhythmic motions, specific character and laterality of these motions, and association with other ictal signs. We recorded the proportion of seizures that involved RINCH activity. We reviewed the results of the presurgical evaluation and in particular recorded the localization and laterality of the seizure focus. ...

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